Sequential Lumen-Apposing Metal Stent and Septotomy Technique for Endoscopic Anastomosis Creation and Revision in Patients with Prior Upper Gastrointestinal Surgery.

Background and aims: We present an endoscopic technique for creation or revision of upper gastrointestinal (UGI) anastomoses using endoscopic ultrasound (EUS) guidance, sequential deployment of lumen-apposing metal stents (LAMS), and septotomy after tract maturation. We also present our case series of 4 patients in which we have successfully utilized this technique for both reversal of post-bariatric surgical anatomy and management of anastomotic strictures.

Methods: 3 patients with prior bariatric surgery underwent reversal of their gastric anatomy with endoscopic anastomosis creation, and 1 patient with a duodenal anastomotic stricture underwent anastomotic revision using our sequential LAMS and septotomy technique.

Results: There were no immediate procedure-related adverse events in any of the cases. All procedures achieved technical and at least partial clinical success.

Conclusions: Our technique is safe, effective, and feasible for durable endoscopic anastomosis creation or revision in appropriately selected patients with prior upper GI surgery.